MEDICARE: SHUNQUELA THOMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP1600X	Pastoral Counselor	OH
3	106S00000X	Behavior Technician	OH
4	171400000X	Health & Wellness Coach	OH
5	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1174143143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUNQUELA THOMAS

Provider Business Mailing Address
First Line	:	11361 LINCOLNSHIRE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-2338
Country	:	US
Telephone Number	:	513-953-7837
Fax Number	:

Provider Business Practice Location Address
First Line	:	11361 LINCOLNSHIRE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-2338
Country	:	US
Telephone Number	:	513-953-7837
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2020
Last Update Date	:	03/15/2025

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Directions to “ SHUNQUELA THOMAS ” Practice Location

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